Provider Demographics
NPI:1881274348
Name:ORCHID OAKRIDGE CLINIC, PC
Entity type:Organization
Organization Name:ORCHID OAKRIDGE CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-373-4165
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0132
Mailing Address - Country:US
Mailing Address - Phone:541-782-8242
Mailing Address - Fax:503-862-5060
Practice Address - Street 1:24934 FIR GROVE LN
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:OR
Practice Address - Zip Code:97437
Practice Address - Country:US
Practice Address - Phone:541-782-8242
Practice Address - Fax:503-862-5060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORCHID OAKRIDGE CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health